Ergonomics.
Ergonomics: The role of
physiotherapy in the
workplace.
BY
Iwuagwu Chukwunyere.
1

Outline.
Definition of ergonomics.
Significance of ergonomics.
Implications of poor ergonomics.
Signs MSD.
Symptoms of MSD.
What are MSDs’?.
Preventions of MSD.
2

Outline condt.
Predisposing risk factors for MSD.
Reducing risk factors for MSD.
Environmental conditions.
Preventions.
Summary.
Slips, Trips and Falls.
Conclusion
References.
3

Definition.
Ergonomics is the scientific study of human at work.
Ergonomic principles adapt work to a specific person
by designing tasks & tools or equipment to fit the
individual to prevent injuries to the musculoskeletal
system (Verhagen et al. 2006).
4

Significance of ergonomics.
•Reduction of work-related injuries
•Increased worker productivity
•Increased work quality
•Reduced absenteeism
•Increased morale
Ergonomics provides a win-win
YOU
JUST
FEEL
BETTER!
5

 An “MSD” is an illness or injury that affects one or
more parts of the musculoskeletal system
 Bones
 Muscles
 Tendons
 Ligaments
 Cartilage
 Nerves
 Blood vessels
 Other common terms for “MSDs”are:
 Cumulative trauma disorder (CTD’s)
 Repetitive strain injures (RSI’s)
 Repetitive motion injuries (RMI’s)
When not diagnosed and treated these can cause
inconvenience permanent pain and disability.
Implications of poor ergonomics.
MSD
MusculoSkeletal Disorders
6

Signs of MSD
 Decreased range of
motion
 Loss of function
 Deformity
 Cramping
 Loss of color
 Decreased grip
strength
 Loss of balance
 Swelling
 Redness
7

SYMPTOMS OF MSD
Muscle fatigue
Pain
Burning Sensation.
Numbness
Stiffness
Tingling
8

What are MSD’S?
 MSD’s are injuries caused by sustained
exposure to stressors or repetitive motion
(English et al. 1995).
 They may affect muscles, tendons, ligaments,
bones, blood vessels, or nerves.
 Some well-known MSD’s are:
Carpel tunnel syndrome
Guyon’s syndrome
Trigger finger
Tennis elbow
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CARPAL TUNNEL SYNDROME
The median nerve does not work properly due to pressure on the
nerve as it runs through an opening called the carpel tunnel
Numbness is usually first symptom.
Pain & tingling, can go up the arm to the
shoulder and neck, causing waking
to pain in middle of night
10

GUYON’S CANAL SYNDROME
Guyon’s affects the ulnar nerve
as it passes through the Guyon
canal in the wrist; this is similar
to carpal tunnel, but involves a
different nerve (Davis et al.1998)
Unlike carpel tunnel, Guyon’s
affects the little and ring fingers.
Can be in conjunction with carpal tunnel
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TRIGGER FINGER
 Trigger finger affects the ability of tendons to
slip back and forth. The tendon and/or
ligament thicken and a nodule forms
 This can be caused by rheumatoid arthritis,
lacerations of tendon, gripping power tools,
long hours of grasping steering wheel, or birth
defects (Aaras 1994).
 Symptoms are pain and
a funny clicking sensation
12

TENNIS ELBOW
 Overuse or misuse of the forearm muscles can cause tendonitis,
or a painful inflammation of the tendons connecting these
muscles to bone (English et al. (1995).
 This condition is brought
on or aggravated by poor leverage
causing an uneven distribution
of force on a few muscles.
 This may be when working,
or during certain leisure activities,
such as sports and gardening.
Symptom are severe pain.
13

ARE MSD’S PREVENTABLE?
 They are preventable and reversible
….. if identified early.
 The treatment depends on the stage of MSD.
 If the condition cannot be reversed, treatment
can turn into a pain management situation.
The individual plays a large role
in preventing MSD’s.
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Predisposing risk factors for MSD
Do you
…perform frequent repetitive motions?
…bend at the waist or twist when lifting objects?
…lift push or pull objects throughout the day?
…sometimes use the wrong tool for the job?
…grasp tools with your fingers?
…forget to take breaks while working?
…feel like you are under stress?
…have to stretch to reach your work?
…forget to adjust your work area to fit your task?
The more you answered “yes”, the greater your risk.
15

RISK FACTORS which can lead to MSDs
(Stressors)
 Awkward posture
 Static loading or sustained exertion
 Contact stress
 Force
 Vibration
 Repetition of same motion for several hours/day
 Length of tasks without breaks
 Insufficient rest time
 Psychosocial stress
These STRESSORS can be influenced by
1. Organizational or administrative precautions
2. Environmental conditions
3. Individual work routine and habits
Most MSDs are the result of combined risk factors
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Reducing RISK FACTORS for MSDs
 The purpose of ergonomic training is to
help you reduce or eliminate the stresses
that can lead to MSDs (Schierhout et al.
1991).
 Your body is designed to do work. When
it works in positions or postures in which
it is designed to deal with physical stress,
there is no problem, but when it is forced
to perform under unnatural situations or
for abnormal periods of time, injuries can
occur.
 Almost all of the ergonomic stresses at
work can be decreased by using the right
equipment in the right position so that the
body can perform in the right posture.
17

Review your Work Area
•You spend most of your day in
your work area.
•You don’t want your work area to
contribute to ergonomic problems
•Ergonomic Rule #1
Work Comfortably!

Use a good CHAIR (adapted from Ando et al 2004)
Front edge of seat pan
curves down
Five feet for base-most stable
Height adjustable
On rollers
Seat pan adjustable
horizontally and
tilts
Backrest provides good lower back support
Arms adjustable
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 The position of your head and neck is very important
 Place computer monitors
directly in front of you
 The right height is person
dependent- usually the top
of the screen at eye level
(or slightly below for those who
wear bifocals)
 The screen should be at least an arms length away
(If you can’t see at that distance, get special computer glasses)
MONITOR HEIGHT
Raise the monitor if you
have to look down at it
20

KEYBOARD STYLES
A variety of styles are available.
Choose one that is comfortable for you.
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KEYBOARD HOLDER
Keyboard holders should
 Tilt
 Provide wrist rests (rest palms not wrist)
 Provide space for a mouse
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MOUSE HOLDERS
Mouse trays or mouse holders can bring a
mouse to a better position
23

MOUSE STYLES
Choose a style comfortable for your hand and fingers
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WORK PLACEMENT
 Position equipment so that your body is in a comfortable and
natural position most of the time while you are working.
 Don’t place things so you have to reach, twist or bend continually
 Place work at monitor height or place in path of monitor
 Listen to your body. If you cannot focus or often feel tired or
uncomfortable, you are probably not working in a good position.
 See what you can do to make your work more comfortable for
you.
Disclaimer: Wait a minute! Though this position may look comfortable, it
is NOT a comfortable position to work in.
Imagine how your back would feel after typing a few pages in this position!
Do not equate comfortable leisure positions with comfortable work positions!
25

Everyone needs a relaxed, neutral position
DO WHAT’S COMFORTABLE FOR YOUR BODY!
Monitor at or below eye
level
Wrists straight
Forearms supported
Back supported
Feet flat on the floor
Forearms and thighs parallel to the
floor
26

MOUSE POSITION
NO!
 Mouse should be
close to the
keyboard and the
same height or
slightly higher
 Locate the mouse
to avoid reaching
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Phone PLACEMENT
Should be different for right and left handers
You should not have to twist and reach across your body
every time you answer the phone.
Many people need to spend a lot of time on the phone, and must
often do other tasks at the same time
This creates a lot of stress
for neck and shoulder muscles
Consider a head set if you spend a lot of time on the phone,
especially if you do other tasks at the same time
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Document PLACEMENT
Place documents so that you don’t
need to bend your head to read while
you keyboard
Consider getting a document holder
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Ergonomic STRESSORS
Environmental conditions
Environmental conditions can
influence ergonomic stress
(Westlander et al. 1998).
Lighting
Noise
Temperature
….even at a computer station!
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LIGHTING & MONITOR GLARE
 Lighting should be
indirect and adequate
 Not too much light,
or it may cause a glare,
headaches and eye
fatigue
 If there is a glare on your
eyes as you work, use
glare screens on
computers, or adjustable
blinds at windows
Ideal is 35-50 foot candles
Ergonomic STRESSORS
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GLARE SCREENS
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Noise can be a STRESSOR
If your office is near a noise source,
close your door, or wear ear plugs
Besides causing ear damage, constant
noise can create extra muscle tension in
the body causing fatigue and making it
easier for ergonomic injuries to occur
(Westlander et al 1998).
Ergonomic STRESSORS
33

Temperature
 People are more prone to ergonomic injuries
in cold environments. Muscles and other
tissues are more tense, because of decreased
circulation (Schierhout et al 1995)..
 Dress appropriately
 Do some warm up exercises, such as
stretching your hands, to loosen your finger
muscles before keyboarding.
Ergonomic STRESSORS
34

MECHANICAL CONTACT STRESS
A hard or sharp surface or object pressing
into the soft tissues, the tendons, nerves
and blood vessels.
Examples:
 Resting wrists on the desk edge while typing or
using mouse
 Leaning elbows on hard chair or armrests or work
surfaces
 Sitting in chair that places pressure on the backs of
the thighs
Ergonomic STRESSORS
35

VIBRATION causes stress
Hand-arm vibration (hand power tools)
Whole body vibration (driving rough off roads)
Even if these do not occur in your work
environment, what about home activities?
Ergonomic STRESSORS
36

HOME-OFFICE CONNECTION
 What happens off the job may influence
stress, discomfort, or pain during the workday
and vise-versa.The two are intertwined.
 Hobbies and recreational activities (golf,
sewing, gardening, etc.) may cause repetitive
motion injuries, which may then be
complicated on the job.
Ergonomic STRESSORS
37

Psycosocial Stress
Any interactions, job tasks or personal problems
which cause psychological or social stress
cause increased muscle tension, which can
make injury more likely. Be aware of these
additional stresses and compensate for them
by taking extra breaks and being especially
careful when under extra pressure (Benard et
al 1994).
Ergonomic STRESSORS
38

INDIVIDUAL STRESSORS
People face different stresses and have
different abilities to cope.
Employees vary in physical condition.
Some individuals are also dealing with
chronic illnesses or disabilities
We don’t live in a vacuum,
life stresses can adversely
effect the wellness of an
individual and contribute to
ergonomic stressors.
Ergonomic STRESSORS
39

Individual work routine and habit
Fortunately,
most STRESSORS can be minimized
or eliminated
by individual habits
and work routine.
The solution to most ergonomic
problems is to work comfortably
and avoid a few common
ergonomic pitfalls.
Prevention of workplace injuries
40

Avoid REPETITION
Performing the same or similar motions repeatedly for
extended periods without time for rest and recovery
can lead to discomfort or trauma (English et al. 1995).
Examples:
 Keyboarding, mousing.
 Flipping through files & paperwork
 Extended reading or writing
 Punching or stapling
 Pruning or clipping
 Painting
 Hammering
Solutions
41

AVOID LONG DURATION OF SAME TASK
 The length of time spent on a task without
breaks, shifts in position, or stretches is more
important than the actual task.
 The longer the uninterrupted duration of a
task, the more potential for discomfort or injury
Our bodies are designed to do work.
But the result on the body of doing a
repetitive task for 2 hours verses 6
hours straight is very different.
Solutions
42

STRETCHES & BREAKS
Solutions
Static positions are your enemy!
Whenever you think of it, change position
Small frequent stretches go a long way in
preventing MSD’s.
43

Stretch Break
 Stretch Break (default), is a software that interrupts you every 30 minutes-
suggests three varied stretches which take a total of 1 minute to
complete. You cannot believe how much better you feel afterwards (Van
den Heuvel et al 2003).
 You can cancel the stretches as soon as they come on the screen,
choose the amount of time you work before being interrupted ( between
10 minutes and 3 hours) and decide which of the many exercises you
want to include, and how many you want to do at each break.
 Such programs are one of the best preventions of ergonomic injuries at a
computer workstation. Even if you choose not to do the exercises, you will
be reminded to shift position, etc periodically so that your muscles do not
become unduly stressed. Most computer related injuries occur because
of projects which engage persons for a substantial length of time.
44

A FEW BREAK IDEAS
 Organize tasks around built in breaks
 Eye breaks - blink to moisten eyes every 5-10 minutes. Every 15
minutes or so look away from the screen to distant part of room.
 Micro-breaks - between burst of activity rest the hands, neck and
shoulders in a relaxed straight posture.
 Rest breaks - every 30-60 minutes take a brief 5-minute break
and engage in another activity.
 Exercise breaks - every 1-2 hours do gentle stretching exercises
Solutions
45

EXERCISES & STRETCHES
These are exercises or stretches that can
be performed at your workstation,
home, just about anywhere.
46

EYE
Eye comfort exercises
Blinking
Yawning
Focus change
47

EYE
Palming
While seated, brace elbows on the edge
of the desk
Let weight fall forward
Cup hands over eyes and close eyes
Inhale slowly through nose & hold for 4
seconds
Continue deep breathing for 15-30
seconds
48

49

EYE
Movements
Close eyes and slowly & gently move
eyes up to the ceiling, then slowly down
to the floor
Repeat 3 times
Close eyes and slowly & gently move
eyes to the left, then slowly to the right
Repeat 3 times
50

NECK STRETCH
Tilt ear towards shoulder
Reach up and touch top of head with
palm to hold in tilted position
Hold 5-10 seconds. Repeat 2-3 times
(come out of stretch slowly)
Reverse side and repeat
51

52

Pec Corner Stretch
 Stand at a corner about a foot away from the
wall with forearms on opposite sides of the
corner. One foot should be forward.
 Elbows should be at slightly below shoulder
height
 Keep abdominals tight to avoid arching back
 Lean gently towards corner by bending the
front knee until a stretch is felt in front of the
chest.
 Hold 5-10 seconds. Repeat 2-3 times
53

Overhead Reach
Take a deep breathe and reach up over
head with both arms.
Hold 5-10 seconds
Exhale and lower slowly
Repeat 2-3 times
54

Shoulder Pinch
Place arms behind head being careful
not to press hand into head
Relax shoulders, and squeeze shoulder
blades together while keeping shoulders
back and down
Hold 5-10 seconds. Repeat 2-3 times
55

56

Shoulder Shrug
Sitting up straight, slowly bring shoulders
up toward your ears.
Hold positions 5-10 seconds
Then bring the shoulders down and hold
Repeat 2-3 times
57

58

Chair Rotation Stretch
Sit in chair and place feet flat on floor
Reach across your body and grab the
back of the chair
Pull gently to increase stretch in mid
back
Hold 5-10 seconds. Repeat 5 times
Repeat on other side
59

60

Arms Behind Back Stretch
Hold hands behind back and grasp
hands together
Pull shoulder blades back and down
Hold 5 seconds. Repeat 5 times
61

62

Thoracic Spine Extension
Stretch
Lie on your back with a pillow under your
knees. Place a firmly rolled towel under
your shoulder blades across your upper
back
Raise arms up as you inhale
Lower arms as you exhale, and hold a
couple of seconds
Do this 5 times
63

Prop Ups or Press Ups
 Lie on stomach and either prop up on
forearms or if wrists are not compromised,
press up through hands.
 Let stomach sag, and allow back to arch
without using back muscles.
 If propped on elbows, hold 5-10 seconds.
Repeat 5 times
 If on hands, press up and down slowly 10
times
64

Foot Rotations
While sitting upright, slowly rotate each
foot from the ankles 3 times in one
direction
Then rotate 3 in the opposite direction
65

Wrist Flexed & Extended
 Hold arm straight at waist height
 With fingers of other hand, gently press down
above the knuckles, bending wrist down. (DO
NOT hold at the fingers to push down.)
 Hold 5-10 seconds and repeat 2-3 times
 For extending, hold onto palm of hand and
stretch wrist back. (DO NOT pull on fingers.)
 Hold 5-10 seconds and repeat 2-3 times.
66

67

68

Finger Massage
VERY gently, massage the fingers of
each hand individually.
Move toward the nail gently.
Massage the space between your
fingers to widen and relax
69

Finger Squeeze
Squeeze a foam block OR the edge of
your desk firmly with all fingers
Hold for 3 seconds
Relax your grip
70

Avoid BAD POSTURES
Bad postures are a primary cause of ergonomic injuries
Everyone has seen these….
Propping a phone on shoulder
Slouching over a computer
Solutions
71

Avoid AWKARD POSITIONS
Awkward positions bend the joints in a way that
they are more likely to become injured.
Examples:
 Reaching up and over
 Slouching or leaning forward in the chair
 Leaning forward or bending over work
 Holding heavy items in position
 Lifting, pushing pulling
 Turning head side to side to view the monitor
 Cradling the phone between the ear and shoulder
 Typing with bent wrists
AWKWARD
POSITIONScreateSTRESS
Solutions
72

Avoid SUSTAINED EXERTIONS
Static loading occurs when muscles must hold
the body in a single position for a long period of
time. Lack of movement reduces circulation
and causes muscle tension
Examples:
 Holding hands in place
 Keeping the head still while reading
 Sitting still for long periods of time
 Sitting upright without back support
STATIC
POSITIONScreateSTRESS
Solutions
73

Lifting (Static Loading)
A large percentage of ergonomic injuries are
due to improper lifting. Planning the lift before
attempting it will prevent most injuries (Ando et
al. 2004).
Solutions
When evaluating a lifting task, consider:
1. The weight of the object
2. What position it must be lifted from and to
3. How many times you will need to lift it
4. If there will be twisting involved
5. If there is good footing, and if you can get a good
grasp on the object
74

Lifting (Static Loading)
 Use a step stool or platform to
reach loads above your head
 For bulky and oversized loads,
get help or use mechanical
aids
 Get a good grip- use handles
when available
Solutions
75

Lifting (Static Loading)
 Don’t pull
 Push
 Get twice the power
 Reduce the risk of injury
Solutions
76

Lifting (Static Loading)
 Get a firm grip on what you are lifting and be sure you are on solid footing
 Squat when lifting something from below the waist. Keep heels down and
feet shoulder-width apart and turned out
 Keep the load close to your body
 Turn your whole body in the direction you want to move- avoid twisting
when lifting
 Keep your knees bent and lean in the direction of the movement
 Let your legs and body weight do the work
 Squat to set loads down
Solutions
77

NO ONE SOLUTION FOR ALL
 People come in all shapes and sizes- what
works for one person may or may not work for
another.
 Ergonomics is a puzzle to be put together for
each individual.
 What works today may or may not work later.
We all change due to time and other
circumstances.
Individualize Solutions
78

ergonomic risk assessment.
Identify types of ergonomic problems
 Look at your daily work tasks
 Identify one or more risk factors
 Review & rethink your work activities/tasks
(including those outside of work).
79

Identify barriers to solving the problems
 Discuss concerns and possible solutions with your
supervisor
 Adjusting work schedules
 Modifying job design
 Rearranging task order
 Changing task assignments
 Consult a Physiotherapist, physician or occupational
therapist if warranted.
80

Identify approaches to overcoming the barriers
 Recommend and/or implement solutions.
 Try something and if it doesn’t feel comfortable,
discontinue and try something else!
 As time passes, try to notice if the problem has truly
been eliminated.
 Let your supervisor know how well the controls are
working.
81

You Can Reduce Risk Greatly
Improve body posture and keep a safe body position
• avoid awkward positions
• use tools and equipment correctly
Rearrange work area-
•control your environment,
•use the right equipment in the right position,
•keep work within reach
Change work habits-
•practice and use correct procedures,
•avoid repetition and long duration of a single task
•take frequent breaks
Apply ergonomic principals at home, too
Summary
82

SLIPS TRIPS FALLS
Real slips, trips and falls are not
funny.
people are injured and work time is lost
by slips, trips, and falls.
83

Slips, Trips and Falls
•Hazards that can lead to slips, trips and falls are often
overlooked, even though they cause many injuries
ranging from minor cuts and sprains to disabling injuries
and even death (Aaras 1994, Ando et al 2004).
•Although slip, trip and fall hazards are easily created,
they are also easy to correct.
•Be aware of such hazards, and correct them quickly,
before the next person becomes a victim!
84

SLIP Hazards
A slip occurs when there is too little friction
or traction between footwear and a walking
surface. Common causes of slips are:
•Slippery floor surfaces
•Liquid, moisture or ice on the floor,
•Food, trash or other small objects
•Oil or grease on the floor
•Footwear without nonskid soles
85

Trip Hazards
A trip occurs when a person’s foot contacts
an object or drops to a lower level
unexpectedly, and they are thrown off
balance.
Some common causes of tripping are:
Desk or file cabinet drawers left open, objects
protruding into passageways and aisles
Electrical or telephone cords that cross passageways and
aisles
Insufficient lighting for walking or working
areas
Furniture that creates
obstacles
Hazardous floor conditions such as
protruding nails, holes or loose boards,
loose carpet and rugs
Elevator cars that do not level off at
the same height of the floor stopped
at
Unsafe stairway conditions or use
Materials stored in passageways, aisles and
stairways
Floor level changes or hidden steps that may not be
obvious
86

Fall Hazards
In addition to falls as a result of slips and trips,
you may be injured if you fall from an elevation.
Some causes of falls are:
•Using makeshift items (boxes, buckets, chairs, etc ) to gain
height
•Not sitting on “4 square” of a chair
•Carrying large or too many items that prevents seeing where
you are going
•Jumping from one level to another
87

In Conclusion…
•Take responsibility for the safety of your work area.
•Report unsafe situations or conditions to your
supervisors.
• Think Safety Act Safely
88

References.
 Verhagen A. et al. (2006). Ergonomic and physiotherapeutic interventions for treating work-
related complaints of the arm neck or shoulder in adults. The cochrane Library (3)
 Ando, S. et al. (2004). Association of self esitmated workloads with musculoskeletal
symptoms among hospital nurses’. Occupational andEnvironmental Medicine, 57(3):21-16.
 Bernard, B. et al. (1994) ‘Job task and psychosocial risk factors for work-related
musculoskeletal disorders among the newspaper employees’. Scandinavian Journal of Work,
Environment and Health, 20(6):417- 426.
 English, C. et al. (1995) ‘Relations between upper limb and soft tissue disorders and
repetitive movement at work’. American Industrial Hygiene Association Journal, 27(1):175-
90.
 Van den Heuvel et al. (2003). Effects of software programs stimulating regular breaks and
exercises on work-related neck and upper limb disorders. Scand J of Work, Environment and
Health 29(2) pg 106-116.
 Viljanen et al. (2003). Effectiveness of dynamic muscle training relaxation training or ordinary
activity for chronic neck pain: Randomised Control Trial. BMJ 327(413) pg. 475.
 Schierhout G H, Meyers J E, Bridgers R S (1995) Work related musculoskeletal disorders
and ergonomic stressors in the South African Workforce. Occupational and Environmental
Medicine. 52(1): 46-50.
 Aaras A. (1994). The impact of ergonomic intervention on individual health and corporate
prosperity in a telecommunications environment. Ergonomics . 37 (10):1679–96.
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 Davis P. et al. (1998). Comparative efficacy of conservative medical and chiropractic
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